5Pure ligamentous injury

If the Lisfranc injury includes a fracture at the base of the 2nd metatarsal, then faster, stronger bone-to-bone healing may be expected.
In the case of a pure ligamentous injury without a fracture at the base of the 2nd metatarsal, post-injury arthrosis is more likely. As such, immediate primary fusion of the first, second and third TMT is now advocated. The joint surfaces are prepared in the usual manner for fusion. The articular cartilage is removed and the subchondral bone is perforated. The hardware construct can be the same as described above, or a variation.